Medical advances hold promise for less-destructive cancer treatment

Published: Monday, March 25, 2013 at 5:48 p.m.

Last Modified: Monday, March 25, 2013 at 5:48 p.m.

Imagine your body as a giant switchboard regulating the communication between billions of cells: If even one circuit breaks, something in your body, at some point, goes wrong.

Facts

Resources for cancer prevention/treatments:

The ACORN clinic in Brooker serves uninsured and underinsured patients in 18 counties and does cancer screenings. For more information on its medical clinic, call 485-1133, ext. 11; for the dental clinic, 485-2772, ext. 24. Fees are based on a sliding scale according to family income and size.

The We Care Physician Referral Network in Alachua County provides medical and dental services to uninsured and low-income patients:http://www.doh.state.fl.us/chdalachua/clinicfamilyhealth/wecare.htm[a]

The Archer Family Clinic in Archer also sees uninsured patients:http://afhc.nursing.ufl.edu/contact/

For the Florida Breast and Cervical Cancer Early Detection Program:http://www.doh.state.fl.us/family/cancer/bcc/index.html[b]

The American Cancer Society provides information on diet and exercise and cancer prevention:www.cancer.org

For county-specific health and socio-demographic information[c]:www.floridacharts.com

www.countyhealthrankings.org

To read the “North Central Florida Cancer Control Collaborative Report” on cancer rates in Alachua and neighboring counties:http://www.cancerresourceguidencf.org/ncfcccdocuments/North-Central-Florida-Cancer-Report-2013.pdf[d]

The faulty circuit, a genetic mutation, could lead to cancer.

Identifying and targeting these genetic mutations is where many scientists see the future of cancer therapy. A trial at Shands at the University of Florida soon could be testing this approach in advanced colorectal cancer patients.

The trial, known as NSABP-FC-7, takes the genetic fingerprint of patients' cancer cells and then gives patients tailored treatments based on that information.

"Instead of saying, ‘You have colon cancer,' we can say, ‘You have colon cancer with these specific genetic characteristics,' " said Dr. Carmen Allegra, a hematologist and oncologist and the associate director for clinical and translational research at the UF&Shands Cancer Center.

"It's a great opportunity to move in a direction of personalizing medicine based on a genetic profile, but as importantly, not use the traditional cytotoxic approach where we just bomb away," Allegra added.

Cytotoxic literally means "kills cells," and the first chemotherapy drugs were actually derived from chemical warfare agents — namely nitrogen mustard used in World War I. Chemotherapy drugs have traditionally killed not just cancer cells but normal, healthy cells — especially fast-growing ones such as hair and intestinal cells, which is why people on chemo often suffer from nausea and lose their hair.

But cancer drugs — including chemotherapy — have become less toxic to the body, and part of the reason is that they now target cancer cells, sparing healthy ones.

"Technology has shown us very specific mutations (in colorectal cancer), and they are targetable," Allegra said.

The UF trial is sponsored by the National Surgical Adjuvant Breast and Bowel Project. Its Genome Assessment Guided Medicine, known as N-GAMe, pays for patients' genetic profiling, and clinicians including Allegra match patients to therapies based on those results.

"The hope is that we'll have multiple trials open that, regardless of what you're profile is, will be able to slot you into a trial," Allegra said. "The idea would be to expand this into the community very quickly."

Patients also could try therapies that the FDA hasn't yet approved, at least not for colorectal cancer specifically. To that end, the pharmaceutical industry is behind the science of genetic profiling, since it's traditionally been in industry's interests to focus on developing drugs that can serve many patients instead of treat various sub-types of the disease, which is what profiling essentially creates, Allegra said.

Dr. Thomas George, an oncologist at Shands who specializes in gastrointestinal cancers and who is working on the trial, said the trial allows for existing drugs — namely neratinib, a drug used for advanced breast cancer — to be tried on colorectal cancer patients.

"We will offer patients the opportunity to try new medications that would not otherwise be available," George said. "We believe this to be of value in shutting down cancer."

Allegra added that this type of mixing and matching of drugs to various cancers is more possible in academic centers and that five others in the United States have joined UF in the trial: Yale University, Washington University in St. Louis, Thomas Jefferson University, the University of Pittsburgh and the Helen Graham Cancer Center in Newark, Del. In Florida, the M.D. Anderson Cancer Center Orlando and Henry Ford Hospital in Detroit are working with the Shands team.

"The goal is to do what we're trying to do here in Florida at a national level," Allegra said.

"I think we're ahead of the curve. We are hoping that Florida is one of the best beneficiaries."

At the other end of the spectrum in colon cancer — prevention — experts insist that screening is the best armor in protecting yourself against the disease. Dr. Thomas Beers, a gastroenterologist at North Florida Regional Medical Center, said polyps in the colon that could turn cancerous are slow-growing, so screening every 10 years once you turn 50 is the current recommendation. That shrinks to every five years if you have a family history of cancer. About 5 percent of the population in the United States develops colon cancer, Beers added.

A high-fiber diet rich in fruits and vegetable is also believed to help prevent colon cancer, but more research is still needed on how diet influences not just colon cancer but all cancers.

"Diets and supplements have always been felt to be helpful for colon cancer prevention, however the larger studies have not panned out," Beers said. "We need more people and more time."

<p>Imagine your body as a giant switchboard regulating the communication between billions of cells: If even one circuit breaks, something in your body, at some point, goes wrong.</p><p>The faulty circuit, a genetic mutation, could lead to cancer.</p><p>Identifying and targeting these genetic mutations is where many scientists see the future of cancer therapy. A trial at Shands at the University of Florida soon could be testing this approach in advanced colorectal cancer patients.</p><p>The trial, known as NSABP-FC-7, takes the genetic fingerprint of patients' cancer cells and then gives patients tailored treatments based on that information.</p><p>"Instead of saying, 'You have colon cancer,' we can say, 'You have colon cancer with these specific genetic characteristics,' " said Dr. Carmen Allegra, a hematologist and oncologist and the associate director for clinical and translational research at the UF&Shands Cancer Center.</p><p>"It's a great opportunity to move in a direction of personalizing medicine based on a genetic profile, but as importantly, not use the traditional cytotoxic approach where we just bomb away," Allegra added.</p><p>Cytotoxic literally means "kills cells," and the first chemotherapy drugs were actually derived from chemical warfare agents — namely nitrogen mustard used in World War I. Chemotherapy drugs have traditionally killed not just cancer cells but normal, healthy cells — especially fast-growing ones such as hair and intestinal cells, which is why people on chemo often suffer from nausea and lose their hair.</p><p>But cancer drugs — including chemotherapy — have become less toxic to the body, and part of the reason is that they now target cancer cells, sparing healthy ones.</p><p>"Technology has shown us very specific mutations (in colorectal cancer), and they are targetable," Allegra said.</p><p>The UF trial is sponsored by the National Surgical Adjuvant Breast and Bowel Project. Its Genome Assessment Guided Medicine, known as N-GAMe, pays for patients' genetic profiling, and clinicians including Allegra match patients to therapies based on those results.</p><p>"The hope is that we'll have multiple trials open that, regardless of what you're profile is, will be able to slot you into a trial," Allegra said. "The idea would be to expand this into the community very quickly."</p><p>Patients also could try therapies that the FDA hasn't yet approved, at least not for colorectal cancer specifically. To that end, the pharmaceutical industry is behind the science of genetic profiling, since it's traditionally been in industry's interests to focus on developing drugs that can serve many patients instead of treat various sub-types of the disease, which is what profiling essentially creates, Allegra said.</p><p>Dr. Thomas George, an oncologist at Shands who specializes in gastrointestinal cancers and who is working on the trial, said the trial allows for existing drugs — namely neratinib, a drug used for advanced breast cancer — to be tried on colorectal cancer patients.</p><p>"We will offer patients the opportunity to try new medications that would not otherwise be available," George said. "We believe this to be of value in shutting down cancer."</p><p>Allegra added that this type of mixing and matching of drugs to various cancers is more possible in academic centers and that five others in the United States have joined UF in the trial: Yale University, Washington University in St. Louis, Thomas Jefferson University, the University of Pittsburgh and the Helen Graham Cancer Center in Newark, Del. In Florida, the M.D. Anderson Cancer Center Orlando and Henry Ford Hospital in Detroit are working with the Shands team.</p><p>"The goal is to do what we're trying to do here in Florida at a national level," Allegra said.</p><p>"I think we're ahead of the curve. We are hoping that Florida is one of the best beneficiaries."</p><p>At the other end of the spectrum in colon cancer — prevention — experts insist that screening is the best armor in protecting yourself against the disease. Dr. Thomas Beers, a gastroenterologist at North Florida Regional Medical Center, said polyps in the colon that could turn cancerous are slow-growing, so screening every 10 years once you turn 50 is the current recommendation. That shrinks to every five years if you have a family history of cancer. About 5 percent of the population in the United States develops colon cancer, Beers added.</p><p>A high-fiber diet rich in fruits and vegetable is also believed to help prevent colon cancer, but more research is still needed on how diet influences not just colon cancer but all cancers.</p><p>"Diets and supplements have always been felt to be helpful for colon cancer prevention, however the larger studies have not panned out," Beers said. "We need more people and more time."</p><p><i>Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.</i></p>